Caring for the carers

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Kate Field of BSI, the British Standards Institution, explains how we can better protect the wellbeing of adult social care workers.

 The importance of employee wellbeing in the care sector has never been more critical. Since the start of the COVID-19 pandemic, media attention may have focused on the extreme demands faced by NHS staff but those working in the adult social care sector have also faced huge challenges. Here, we unpick why that is what can be done to manage their needs and outline how to create a culture of care for the carers.  

What is a healthy workplace? 

First of all, what do we mean by wellbeing at work? ISO 45003 – the first global standard giving practical guidance on managing psychological health and safety at work – defines it as ‘the fulfilment of the physical, mental and cognitive needs of a worker related to their work.’ That encompasses the needs of the employer, who requires work to be done at the right time and in a certain way. It also includes  the needs   of the employee, who expects to work safely and have a manageable workload. Workforce wellbeing is under threat  when these needs are not aligned. This could be through simple health and safety failures, or more complex issues related to work pressure, management style, insecurity, and change.  

Wellbeing at work is not simply a ‘nice to have’ add-on for employers, it’s vital for the health of the workforce and the organization. Employee engagement, job satisfaction, productivity, financial and organizational performance. All these factors improve in a healthy workplace. 

What are the challenges?

The challenges to wellbeing in the social care workforce are many and varied, with low pay, high turnover, job insecurity, insufficient training and poor working conditions nearing the top of the list. Its negative reputation for cost-cutting and paying wages that are often well below the national average is compounded by the fact that many contracts are part-time, zero hours, or casual arrangements. That coupled with the sheer physical and emotional strain of dealing with the most vulnerable in society means myriad stresses are placed upon the adult social care sector workforce, stresses which can lead to mental health issues, fatigue and burnout.  

Part of the reason for low pay and high instability in the sector is the narrow margins that many care businesses operate at, driven by lack of funding. Countries around the world vary in how long-term adult social care is paid for (usually a mixture of state and private funding), but it is often organised and funded separately from healthcare, seen as a ‘poor relation’ compared with funding on acute medical services. 

Of one issue there is no doubt – the ageing global population is increasing the numbers of people requiring care in later life, in all countries. With this comes  an increase in costs and concern about how these costs should be met.  

What difference does COVID-19 make?

The past two years have created a perfect storm for the adult social care sector and the pandemic has taken a huge toll on its workers. The usual levels of occupational stress have been compounded by fear of infection, financial insecurity, overwork and the distress of witnessing the suffering and death of those they care for. 

Outbreaks in residential care homes for the elderly leads to high transmission rates, sickness, and sadly, all too many deaths. In long term care, when staff and residents become like family, the emotional impact of loss and grief cannot be underestimated.  

Measures to control infection means many residents may not be allowed to see family or friends for months on end, leading to isolation and frustration. In addition, infection control is often made more difficult by problems obtaining appropriate personal protective equipment (PPE) for workers, or access to testing kits.  

Those with casual or zero-hours contracts are often not eligible for sick pay, meaning they either suffer financially if they become sick or need to quarantine – or they continue to work, risking infection and transmission of the virus. High levels of absence means an increased workload for those still able to work.  

Time for change – initiatives for wellbeing

Employers are giving more attention to the concept of well-being in the workforce, including the introduction of wellbeing programmes. But definitions of what those programmes should be differs widely, ranging from encouraging staff to eat healthily and take exercise, to the provision of comprehensive employee assistance programmes.  

According to the Chartered Institute for Personnel Development (CIPD), effective wellbeing programmes should be proactive, promoting a healthy working culture by identifying potential causes of work-related ill health and taking action to address them. They need to be embedded in the culture of the organisation and supported by senior management, rather than seen as ‘add-on’ benefits.  

Examining the threats to health

Occupational stress risk assessments are a key part of prevention of ill health, says Rachel Suff, Senior Policy Adviser for Employment Relations at CIPD. They can be in the form of questionnaires, focus groups or simply conversations with staff. Kate Field, Global Head of Health, Safety and Wellbeing at BSI said, ‘ The reality is that workers know what the issues are and what is having an impact, so ask them.’ Assessments identify situations in the workplace which can lead to an unhealthy build-up of stress, with the potential to result in staff burnout.  

Unmanageable workloads and managing staff

We know that adult social care workers are very likely to have faced increased workloads during COVID-19, so employers need to rethink their priorities in times of crisis to avoid repeating mistakes. Establish what is absolutely essential, what projects can be put on hold and what deadlines can be moved. Adopt good workforce planning, making sure your staff are suited to and trained for the jobs they do. 

Ensure too that your line managers are carefully selected, not just on the basis of their technical skills, but also on their emotional intelligence and management capabilities. Can they build relationships, do they check in with staff regularly and offer ways to support and care for them? Can they identify the signs of burnout? 

Ensuring a safe environment

Supporting the wellbeing of staff working in this sector should begin with ensuring basic needs are met. Do they have adequate food or PPE, are they free to take regular breaks, will they have income if on sick leave or unable to work?   

During the pandemic, the UK’s Social Care Institute for Excellence (SCIE) brought together employee assistance resources, demonstrating examples of good practice. This included the provision of safe spaces for staff struggling with their emotions, wellbeing support phone lines, training for managers, mental health first aiders and team meetings to allow staff to express views. 

Long-term change

It is vital that wellbeing initiatives in the adult social care workforce endure once COVID-19 has passed. Measures that have been put in place must remain, although the perennial problems of low pay, under-staffing and a negative image is  likely to remain. Those working in this sector should expect the same respect and support that those in the medical sector have received during the pandemic. 

Improved long-term and stable funding for the sector would certainly help address the wellbeing of social care staff. Countries from the UK to Australia to the US have pledged repeatedly to address this thorny issue, which will only get more acute as the population ages.  

Beyond funding, what needs to happen to create a culture of well-being in the social care sector?  

Creating a culture of well-being

In the wake of the pandemic, the CIPD recommends organizations should develop a holistic and systematic framework with tools to assess the physical and psychological risks to workers’ health, to target action in the right places. Its 2021 report concluded: ‘It shouldn’t have taken a global pandemic to push people’s health and wellbeing to the top of the corporate agenda as a critical business continuity issue. Now, the challenge , is to ensure employers view employee health and wellbeing as a strategic imperative beyond COVID-19.’  

Taking a holistic view of wellbeing requires commitment from all levels of the organisation. It also requires knowledge – the ability to survey the wellbeing of staff within an organisation, to benchmark performance against standards, and to identify and target areas where wellbeing is at risk.  

Resources include the UK Health and Safety Executive’s ‘Stress Indicator Tool’ which helps employers to identify stressful situations which could lead to ill health; the international standard ISO 45003 which allows organizations to implement global good practice on managing psychological health and safety; and BSI’s Prioritizing People Model©.  

For organizations that want to create a culture of trust and a healthy workplace the Prioritizing People Model© sets out a complete, best practice framework on workplace well-being, one that creates the right conditions for individual fulfilment and organizational resilience.  

What next?

The COVID-19 pandemic shines a light on an already over-stretched and marginalized workforce. If the adult social care sector is to survive and meet the challenge of increased demand from an ageing population, it needs to take care of its staff. There are many good employers out there, but tight margins make it difficult to offer better pay and working conditions.  

In the absence of a big increase in funding, the sector needs to look to what can be done to improve wellbeing through good communication, proactive risk assessment and well- trained management.  

Only by caring for the carers will societies be able to rely on them to continue to care for the most vulnerable as the world begins to emerge from the COVID-19 crisis, and into whatever unforeseen crises may lie ahead. 


Kate Field

Kate Field is Global Head of Health, Safety and Well-being for BSI, the business improvement organization. Visit https://www.bsigroup.com/en-gb/healthcare/hospitals-and-care-facilities/whitepapers/protecting-the-well-being-of-people-working-in-adult-social-care/ to download the full whitepaper 

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